Objective: To evaluate in vitro and in vivo effects of Moses technology in Holmium laser and to compare it with the Regular mode in terms of lithotripsy efficiency and laser-tissue interactions.Methods: The Lumenis® Pulse™ P120H holmium laser system together with Moses D/F/L fibers were used to compare the Regular mode with the Moses modes in stone retropulsion by using a high-speed camera, and stone ablation efficiency. In addition, a porcine ureteroscopy model was used to assess stone fragmentation and dusting as well as laser-tissue interaction with the ureteral wall.Results: After a laser pulse, in vitro stone displacement experiments showed a significant reduction in retropulsion when using the Moses mode. The stone movement was reduced by 50 times at 0.8 J and 10 Hz (p < 0.01). The pronounced reduction of retropulsion in the Moses mode was clearly observed during fragmentation setting (high energy) and dusting (low energy, high Hz). In addition, stone fragmentation tests showed that the Moses modes resulted in a significantly higher ablation volume when compared with the Regular mode (160% higher; p < 0.001). In vivo assessment also supported the reduction in retropulsion when treating stones in the porcine kidney. Histological analysis of the porcine ureter after direct lasing in the Moses mode suggested less damage than in the Regular mode.Conclusions: The Moses technology resulted in more efficient laser lithotripsy, in addition to significantly reduced stone retropulsion, and displayed a margin of safety that may result in a shorter procedural time and safer lithotripsy.
Objective: To compare regular and Moses modes of holmium laser lithotripsy during ureteroscopy in terms of fragmentation/pulverization and procedural times in addition to perioperative complications. Patients and Methods: After obtaining ethics approval, a prospective double-blinded randomized trial was conducted for patients undergoing holmium laser lithotripsy during retrograde ureteroscopy. Patients were randomly assigned to either regular or Moses modes. Patients and surgeons were blinded to the laser mode. Lumenis 120W generator with 200 Moses D/F/L fibers were used. Demographic data, stone parameters, perioperative complications, and success rates were compared. The degree of stone retropulsion was graded on a Likert scale from 0-no retropulsion to 3-maximum retropulsion. Results: A total of 72 patients were included in the study (36 per arm). Both groups were comparable in terms of age and preoperative stone size (1.4 cm vs 1.7 cm, p > 0.05). When compared with the regular mode, Moses mode was associated with significantly lower fragmentation/pulverization time (21.1 minutes vs 14.2 minutes; p = 0.03) and procedural time (50.9 minutes vs 41.1 minutes, p = 0.03). However, there were no significant differences in terms of lasing time (7.4 minutes vs 6.1 minutes, p > 0.05) and total energy applied to the stones (11.1 kJ vs 10.8 kJ, p > 0.05). Moses mode was associated with significantly less retropulsion (mean grade was 1.0 vs 0.5, p = 0.01). There were no significant differences between both modes in terms of intraoperative complications (11.1% vs 8.3%, p > 0.05), with one patient requiring endoureterotomy for stricture in the Moses group. Success rate at the end of 3 months was comparable between both groups (83.3% vs 88.4%, p > 0.05). Conclusion: Moses technology was associated with significantly lower fragmentation/pulverization and procedural times. The reduced fragmentation/pulverization time seen using Moses technology could be explained by the significantly lower retropulsion of stones during laser lithotripsy.
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